Evaluation Of Ischemic Penumbra In The Treatment Of Acute Ischemic Stroke Patients With Integrated Chinese And Western Medicine Based On 3D-ASL

BackgroundWith the increase of people’s living standard,the change of diet and living habits leads to the increasing number of ischemic stroke patients,which seriously endangers health.Early diagnosis of ischemic stroke is particularly important,and imaging evaluation has important guiding significance.Stroke,also known as stroke in traditional Chinese medicine,is an acute cerebrovascular disease.It is divided into hemorrhagic stroke and ischemic stroke,of which ischemic stroke accounts for 70%to 80%.The key to the treatment of ischemic stroke is to open the occlusive blood vessels as soon as possible and save the ischemic penumbra.Although intravenous thrombolysis is generally recognized as the preferred treatment internationally,the time limit of intravenous thrombolysis makes it impossible for most patients to apply it.After the time window is exceeded,the benefit of vascular opening may decrease,and the risk of bleeding increases.Therefore,the vast majority of patients still choose the conservative drug treatment plan.According to the patient’s situation,the use of Chinese medicine or proprietary Chinese medicine treatment has its unique advantages.The National Institutes of Health Stroke Scale(NIHSS),Functional Independence Rating(FIM),Modified Rankin Scale(MRS),etc.,are often used to evaluate the therapeutic effect of ischemic stroke in clinical practice,which cannot be quantitatively analyzed.In this paper,3D-ASL was used to quantitatively evaluate t the therapeutic effect of integrated Chinese and Western medicine on acute ischemic stroke.Objective3D-ASL was used to measure cerebral blood flow(CBF)in patients with acute ischemic stroke.By analyzing the changes of CBF in ASL images of patients with ischemic stroke before and after treatment with Chinese and western medicine,explore the application value of post labeling delay time(PLD)ASL in acute ischemic stroke and evaluate the value of ischemic penumbra in the treatment of integrated Chinese and Western medicine.MethodsAs the research subjects,we selected 40 patients with acute ischemic stroke who were hospitalized and received treatment between June 2021 and June 2023.These patients were from Henan Provincial Hospital of Traditional Chinese Medicine.All patients underwent MRI,including plain scan sequence,MRA sequence,DWI sequence and 3D-ASL sequence scanning.The 3D-ASL sequences were detected by PLD 1.5s and PLD 2.5s respectively.In addition,we collect the clinical data of all patients,and the DWI images of patients were fused with the ASL images of different PLD.When the area of hypoperfusion on ASL is greater than the area of hyperintensity on DWI,indicating the presence of ischemic penumbral zone(IP).Therefore,the patients were divided into IP group and no IP group.All patients were treated with integrated Chinese and western medicine.After 14 days of treatment,ASL examination was performed with the same machine and scanning conditions.CBF values of infarction area and mirror area were recorded before and after treatment in both groups,At the same time,the NIHSS scale scores of the two groups before and after treatment were recorded.and the significance of ischemic penumbra in the treatment of ischemic stroke was analyzed.Results(1)Among the 40 patients,the area of ASL low perfusion area was larger than the area of DWI high signal area in 23 patients,which was the IP group;the area of ASL low perfusion area was about equal to the area of DWI high signal area in 17 patients,which was the no IP group(2)There were no significant differences in gender,age,time from stroke onset to hospital admission,underlying diseases,smoking and drinking between the IP group and the non-IP group(P > 0.05).(3)With PLD1.5 and PLD2.5,The CBF in the core area of infarction was lower than that in the contralateral mirror area,with statistical significance(P < 0.05);With PLD1.5s,CBF in infarct core area was lower than PLD2.5s,and the difference was statistically significant(P < 0.05).At PLD1.5s,the contralateral CBF compared with PLD2.5 image area,there was no statistically significant difference(P >0.05).(4)When PLD1.5 and PLD2.5 were used in IP group,CBF of cerebral blood flow in the infarction core area and ischemic penumbral zone after treatment was higher than that before treatment,and the difference was statistically significant(P < 0.05).(5)In the patients without IP group,the CBF of cerebral blood flow in the core area of infarction after treatment was higher than that before treatment at PLD1.5 and PLD2.5,and the difference was statistically significant(P < 0.05).(6)The difference of CBF before and after treatment was compared between the two groups,△CBF= CBF after treatment-CBF before treatment,and the difference between the two groups was statistically significant(P < 0.05).The blood flow improvement was better in the IP group.Conclusion(1)PLD1.5s combined with PLD2.5s can more comprehensively observe the actual blood perfusion in patients with acute ischemic stroke.(2)ASL can quantitatively analyze the changes of cerebral blood flow before and after the treatment of acute ischemic stroke,and can be used as an effective way to evaluate the therapeutic effect of integrated Chinese and western medicine for acute ischemic stroke.(3)Patients with ischemic penumbra after treatment with integrated Chinese and Western medicine are more effective than patients without ischemic penumbra.Ischemic penumbra is of guiding significance for drug treatment of acute ischemic stroke.